Gout Te porohau

A lot of people think that gout is caused by food and drink such as seafood, meat, and beer. However, what you eat and drink only makes a small difference to your uric acid (also called urate).

High uric acid is mainly affected by your genes (passed on by your parents), your kidneys, and your weight.

Your kidneys usually filter out extra uric acid which then comes out in your wee (urine).

If you do not get rid of enough uric acid, the levels in your blood increase. The uric acid can then turn into tiny, sharp, glass-like crystals which collect in your joints causing gout.

The crystals can also cause small, hard, painless lumps under your skin called tophi.

Māori and Pacific peoples are more likely to have the gene that stops their kidneys getting rid of enough uric acid.

Gout causes severe pain, swelling, heat and redness in one or more of your joints. It often affects your big toe but can affect your:

• knee
• foot
• wrist
• ankle
• hand
• elbow joints.

Often the joint is very sore to touch — even the light pressure of your bed sheets can be extremely painful.

It can come on suddenly and often starts at night. Without treatment, a gout attack usually lasts about a week.

Your healthcare provider will ask you about your symptoms and examine the affected parts of your body. They can usually diagnose gout by examining your sore joint. They will arrange a blood test to measure your uric acid levels, either at the time of your attack, or later.

If it is not clear whether you have gout or a joint infection, you may need to have a procedure called a joint aspiration. This involves taking fluid out of the affected joint using a needle and syringe. The fluid is sent to a laboratory to be tested.

Anti-inflammatory medicines are used for an attack of gout. They reduce pain and inflammation in the joints. These medicines include:

• non-steroidal anti-inflammatory drugs (NSAIDs)
• steroids (also called corticosteroids), most often prednisone
• colchicine.

Steroids may be given as a tablet or as an injection into your joint or muscle. If you cannot take NSAIDs or steroids your healthcare provider may prescribe colchicine.

All anti-inflammatory medicines can have serious side effects, especially if they are used for more than a few days. This is especially important if you have other health conditions and are taking other medicines.

Your healthcare provider will discuss the medicines with you and give you advice on what is most appropriate for you.

Pain relief medicines for adults

Your healthcare provider will recommend you take medication to lower the uric acid in your blood if you have:

• had more than 2 attacks of gout in a year
• complications of gout such as joint damage or kidney stones
• a strong family history.

This will reduce your chance of getting acute gout and long-term damage.

The goal with this medication is to keep your uric acid levels below 0.36 mmol/L. You will need blood tests to check your levels.

• You usually start the medication at a low dose and increase it slowly to reduce side effects.
• It can take weeks to months to work and you may get gout attacks when you are first taking it. You may need to take an anti-inflammatory medicine with your preventer for the first few months.
• It is important to take your urate-lowering medicine every day, even when you feel well. Continue taking it while you have a gout attack.

Urate-lowering medication is an ongoing, long-term treatment that you have to continue taking for many years.

• Allopurinol is the most commonly used urate-lowering medication.
• If you cannot take allopurinol, your healthcare provider may prescribe another medicine such as probenecid or febuxostat.

You may also be prescribed colchicine when you start on urate-lowering medications. Colchicine can treat a gout attack but also reduces the risk of having another one while you are starting urate-lowering therapy.